title: Cranial distraction osteogenesis for syndromic craniosynostosis: long-term follow-up and effect on postoperative cranial growth.
abstract: BACKGROUND
  Although cranial distraction osteogenesis (CDO) is beneficial, few studies have reported on detailed operative procedures and postoperative cranial growth. Herein, we demonstrated the objective effectiveness of CDO in younger infants.
  
  
  METHODS
  The study included infants who underwent primary cranial distraction for craniosynostosis. Infants who had hydrocephalus were excluded and those who underwent additional osteotomy surgeries were analysed before the subsequent procedures. The infants' computed tomography data were analysed using Mimics(®) software (Materialise, Leuven, Belgium) to calculate the cranial volumes and compare them with the Abbott curve for a normal population. We defined cranial growth gap as the difference between the subject data and normal infant data to demonstrate the perioperative effects on cranial growth.
  
  
  RESULTS
  CDO was performed in 10 infants. The mean infant age at the time of surgery was 6.4 months (range, 24--61 months) and the mean duration of postoperative follow-up was 38.9 months (range, 24--61 months). Five infants with Crouzon syndrome and five with Apert's syndrome were included. All infants showed postoperative cranial growth, but cranial growth gap showed postoperative declines for a certain period, indicating cranial growth suppression immediately following expansion. At the last follow-up, all cases were within ±2 standard deviation (SD) compared with the normal population. We derived a formula to predict the CDO target volume using the declining cranial growth gap curve.
  
  
  CONCLUSIONS
  CDO was applicable and suitable for younger infants requiring aggressive cranial expansion.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Osaka General City Hospital, 22-13-2 Miyakojimahondori, Miyakojima-ku, Osaka City, Osaka, Japan. Electronic address: kuru3641@gmail.com.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Yamaguchi
authors.affiliation: Department of Plastic and Reconstructive Surgery, Osaka General City Hospital, 22-13-2 Miyakojimahondori, Miyakojima-ku, Osaka City, Osaka, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Imai
authors.affiliation: Department of Plastic and Reconstructive Surgery, Osaka General City Hospital, 22-13-2 Miyakojimahondori, Miyakojima-ku, Osaka City, Osaka, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Fujimoto
authors.affiliation: Department of Plastic and Reconstructive Surgery, Osaka General City Hospital, 22-13-2 Miyakojimahondori, Miyakojima-ku, Osaka City, Osaka, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: Department of Plastic and Reconstructive Surgery, Osaka General City Hospital, 22-13-2 Miyakojimahondori, Miyakojima-ku, Osaka City, Osaka, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Maruyama
authors.affiliation: Department of Pediatric Neurosurgery, Osaka General City Hospital, 22-13-2 Miyakojimahondori, Miyakojima-ku, Osaka City, Osaka, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sakamoto
authors.affiliation: Department of Pediatric Neurosurgery, Osaka General City Hospital, 22-13-2 Miyakojimahondori, Miyakojima-ku, Osaka City, Osaka, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Matsusaka
mesh_terms: D000168:Acrocephalosyndactylia / Q000601:surgery*; D003394:Craniofacial Dysostosis / Q000601:surgery*; D003398:Craniosynostoses / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009929:Organ Size; D019857:Osteogenesis, Distraction; D012016:Reference Values; D012886:Skull / Q000254:growth & development*; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: Cranial distraction osteogenesis; Cranial growth; Craniosynostosis; Long-term follow-up